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Selecting Medicare Advantage Plans

If you’re approaching retirement, it’s time to learn about your Medicare options. This federal health insurance program provides coverage for people age 65 and older (and some younger people with certain disabilities). Could a Medicare Advantage Plan be right for you? Here’s everything you need to know.

What are Medicare Advantage Plans?

Medicare coverage is divided into four parts:

  • Part A covers hospital stays.

  • Part B covers doctors’ services, such as outpatient care, medical supplies and preventative services. When you enroll in Original Medicare, you are signing up for Part A and Part B coverage directly from Medicare.

  • Part C is called Medicare Advantage, or MA. It covers everything in Part A and Part B. However, instead of obtaining coverage directly from Medicare, you obtain Medicare Advantage from a private insurance company approved by Medicare.

  • Part D covers prescription drug costs. Most Medicare Advantage Plans also cover Part D. If not, you can purchase Part D coverage separately. However, you can’t be enrolled in a Part D Plan if your Medicare Advantage Plan offers prescription drug coverage.

What does Medicare Advantage Cover?

No matter which private insurance company you obtain a Medicare Advantage Plan from, you can expect it to cover all the services that Original Medicare covers, from emergency to urgent care needs – but not hospice care. However, even if you have Medicare Advantage, Original Medicare will still cover your hospice care needs.

Medicare Advantage often covers additional services that Original Medicare does not. These may include:

  • Vision

  • Hearing

  • Dental

  • Health and wellness programs

  • Medicare prescription drug coverage (Plan D)

Your plan may not cover services that aren’t deemed medically necessary. If you’re not sure whether a service is covered, contact your provider. If the plan won’t pay for a service you think you need, you’ll have to pay the entire cost. However, you have the right to appeal the decision.

It’s also important to know that you can’t obtain a Medigap policy (which helps cover Original Medicare co-payments, coinsurance and deductibles) if you have a Medicare Advantage Plan.

Enrollment Windows

  • Initial Enrollment Period: The best time to enroll in Medicare Advantage is within the seven-month window surrounding the month you turn 65. This includes three months preceding your birth month, your birth month, and three months after your birth month.

  • Medicare Open Enrollment: Every year, Oct. 15 thru Dec. 7 marks Open Enrollment. This is your chance to change your Medicare coverage.

  • Medicare Advantage Disenrollment Period: Every year, Jan. 1 thru Feb. 14 is your chance to leave a Medicare Advantage Plan and switch to Original Medicare.

  • Special Enrollment Period: If you move, are eligible for Medicaid, live in a nursing home, leave coverage from your employer or qualify in another way, you may be eligible for special enrollment at a different time of year.

Types of Medicare Advantage Plans

  • Health Maintenance Organization (HMO): You select a primary care doctor, receive service coverage only within the plan’s network, and require a referral to see a specialist. HMOs have relatively strict rules, but lower plan costs may be worth it.

  • Preferred Provider Organization (PPO): You can go to any doctor or hospital, but costs are lower if you use those within the plan’s network. Also, you may not need a referral to see a specialist. PPOs are less restrictive than HMOs, but monthly premiums may be higher.

  • Private Fee-For-Service (PFFS): Most plans have no network restrictions, but not all Medicare providers accept PFFS Plans.

  • Special Needs Plan (SNP): You may qualify for the tailored benefits of an SNP if you have chronic heart failure or dementia, are enrolled in both Medicare and Medicaid, or live in a nursing home.

  • HMO Point-of-Service (HMO POS): This less common version of an HMO lets you receive covered care outside the plan’s network for a higher out-of-pocket cost.

  • Medical Savings Account (MSA): This less common, high-deductible plan involves having Medicare deposit a portion of your premium into a bank account. You can use this money to pay for healthcare expenses throughout the year.

HMOs and PPOs are the most common Medicare Advantage Plans. The plan you choose depends on your medical needs, desired primary care doctor and budget. Work with an insurance provider to help you choose the best MA Plan for you.


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